Preventing adverse sequelae of bacterial vaginosis - A public health program and research agenda

Background: The cause of bacterial vaginosis remains poorly understood, Rec ent evidence strengthens the association between bacterial vaginosis and se rious medical complications, Goal: To review the evidence linking bacterial vaginosis with adverse pregn ancy outcomes, complications after gynecologic procedures, and HIV infectio n, and to identify prevention strategies. Methods: In March 1999. the Centers for Disease Control and Prevention orga nized a conference to accomplish this goal. Results: Better understanding is needed concerning the etiology, epidemiolo gy, and natural history of bacterial vaginosis, More efficacious treatment of bacterial vaginosis and strategies to reduce maternal complications asso ciated with bacterial vaginosis, such as premature rupture of the fetal mem branes, chorioamnionitis, premature labor and delivery, postdelivery endome tritis, and postpartum infant complications should be developed. Recent evi dence shows that screening and treatment of bacterial vaginosis before abor tion reduces postabortion pelvic inflammatory disease, and that anaerobic c overage during hysterectomy reduces postoperative complications. Better und erstanding concerning the relation of bacterial vaginosis to acquisition of sexually transmitted diseases and HIV infection are needed as well as poss ible prevention strategies. Conclusions: A national prevention effort should be guided by the results o f research that addresses current knowledge gaps.